Provider Demographics
NPI:1265871537
Name:PARADIE, TARA E (MSPT)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:E
Last Name:PARADIE
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-4675
Mailing Address - Country:US
Mailing Address - Phone:207-782-6916
Mailing Address - Fax:
Practice Address - Street 1:100 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-4675
Practice Address - Country:US
Practice Address - Phone:207-782-6916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT1414174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist